The facility will indicate by placing an “X” in the “Available” column if the payment option is accepted (may check more than one). Please indicate in the “Comments” column below if a pre-determined length of private funds payment source is required before acceptance of Medicaid or waivered service funds; and if yes, indicate the number of months required.
Payment Options for Housing Contract
| Payment Option | Accepted | Comments |
|---|---|---|
| Private Pay | ✓ | |
| Housing Support (formerly Minnesota Group Residential Housing) Payments | ✓ | Other; explain |
Payment Options for Services
| Payment Option | Accepted | Comments |
|---|---|---|
| Waivered Services (EW, CADI, BI); specify any limitations | ✓ | |
| Private Pay | ✓ | |
| Long Term Care Insurance | ✓ | |
| Waivered Services TBI | ✓ | |
| Others;explain |